Evaluation of dynamic contrast-enhanced T1-weighted perfusion MRI in the differentiation of tumor recurrence from radiation necrosis
Evaluation of dynamic contrast-enhanced T1-weighted perfusion MRI in the differentiation of tumor recurrence from radiation necrosis
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DOI：
10.1007/s00234-012-1127-4
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发表时间：
2013-02-01
期刊：
影响因子：
2.8
通讯作者：
Hansen, Adam E.
中科院分区：
文献类型：
--
作者：
Larsen, Vibeke A.;Simonsen, Helle J.;Hansen, Adam E.
为了探讨动态增强磁共振成像(DCE-MRI)血流灌注测量是否可以用于鉴别高级别胶质瘤患者的放射性坏死和肿瘤复发。这项研究得到了机构审查委员会的批准，并获得了所有受试者的知情同意。19例脑胶质瘤患者接受了手术和放射治疗。患者有增强的病灶，在标准的MRI检查中不能完全确定为复发或放射性坏死。DCE-MRI测量脑血容量(CBV)、血脑屏障通透性(BBB)和脑血流量(CBF)。受试者还接受了FDG-PET，病变被归类为代谢活跃或不活跃。通过随访临床、MRI和病变组织学来判断病变是消退型还是进展型。14个强化病变可分为进展型(11个)或退化型(3个)。CBV的经验阈值为2.0ml/100g时，检测退行性病变的敏感度和特异度均为100%。在获得FDG-PET分类的16例中，有13例FDG-PET和DCE-MRI对肿瘤状态的分类是一致的。在剩下的三名患者中，有两名患者获得了MRI随访和组织学检查，两者都表明DCE-MRI的答案是正确的。使用DCE-MRI测量CBV可以预测对比剂增强的病变状态，并在区分肿瘤复发和放射性坏死方面得出与FDG-PET非常相似的结果。
To investigate if perfusion measured with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to differentiate radiation necrosis from tumor recurrence in patients with high-grade glioma.The study was approved by the institutional review board and informed consent was obtained from all subjects. 19 patients were recruited following surgery and radiation therapy for glioma. Patients had contrast enhancing lesions, which during the standard MRI examination could not be exclusively determined as recurrence or radiation necrosis. DCE-MRI was used to measure cerebral blood volume (CBV), blood-brain barrier (BBB) permeability and cerebral blood flow (CBF). Subjects also underwent FDG-PET and lesions were classified as either metabolically active or inactive. Follow-up clinical MRI and lesion histology in case of additional tissue resection was used to determine whether lesions were regressing or progressing.Fourteen enhancing lesions could be classified as progressing (11) or regressing (three). An empirical threshold of 2.0 ml/100 g for CBV allowed detection of regressing lesions with a sensitivity of 100 % and specificity of 100 %. FDG-PET and DCE-MRI agreed in classification of tumor status in 13 out of the 16 cases where an FDG-PET classification was obtained. In two of the remaining three patients, MRI follow-up and histology was available and both indicated that the DCE-MRI answer was correct.CBV measurements using DCE-MRI may predict the status of contrast enhancing lesions and give results very similar to FDG-PET with regards to differentiation between tumor recurrence and radiation necrosis.